Provider Demographics
NPI:1013670264
Name:2400 HOME, LLC
Entity Type:Organization
Organization Name:2400 HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:POUPPIRT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-778-8236
Mailing Address - Street 1:2400 DUNN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3216
Mailing Address - Country:US
Mailing Address - Phone:307-778-8236
Mailing Address - Fax:307-632-4338
Practice Address - Street 1:2400 DUNN AVE STE B
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3216
Practice Address - Country:US
Practice Address - Phone:307-778-8236
Practice Address - Fax:307-632-4338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care